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This guidance has been developed to aid in the identification and response to young people who are at risk of, or experiencing sexual exploitation. It is for all health professionals in NHSGGC.
This guidance is applicable to all young people under 18 yrs.
Children and young people who are sexually exploited can present across a range of health settings in a variety of ways: poor self-care, injuries, sexually transmitted infections, contraception, pregnancy, termination, drug and alcohol problems, medically unexplained symptoms, mental health problems, self-harming behaviours, problem behaviours, problems in relationships. They may not recognise they are being sexually exploited as they may perceive the perpetrator as meeting their needs in some way (giving them something they need or want). This may change over time as the perpetrator’s behaviour becomes more coercive, but, a fear of potential consequences may stop them from disclosing. Child Sexual Exploitation: Improving Recognition and Response in Health Settings, Academy of Medical Royal Colleges, 2014
There are different ways in which sexual exploitation may take place such as:
Both girls and boys can be sexually exploited (72% of cases identified in the Office of Children’s Commissioner’s Inquiry were girls, 9% were boys, and 19% were not gender specified).
This policy reflects NHSGGC’s commitment to promoting equality and diversity as outlined in the Equality Act 2010.We are committed to developing and promoting policies and procedures to meet individual needs in a positive and supportive way. All procedures are implicit of people’s rights not to be discriminated against regardless of race, gender, ability needs, sexual orientation, age or religion.
The sexual exploitation of children and young people is often a hidden form of child sexual abuse with distinctive elements of exploitation and exchange. In practice, the sexual exploitation of children and young people under 18 might involve young people being coerced, manipulated, forced or deceived into performing and/or others performing on them, sexual activities in exchange for receiving some form of material goods or other entity (for example, food, accommodation, drugs, alcohol, cigarettes, gifts, affection). Sexual exploitation can occur through the use of technology and without the child’s immediate recognition.
In all cases those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are often common features; involvement in exploitative relationships being characterised in the main by the child/young person’s limited availability of choice resulting from their social, economic and/or emotional vulnerability. Child Protection Guidance, Scottish Government, 2014
In 2012, the Child Exploitation and Online Protection Centre (CEOP) found almost half of perpetrators were under 25 years of age, mostly men, of all ethnic groups.
The perpetrators of sexual exploitation are known to target areas where children and young people might gather with limited adult supervision such as shopping centres, cafes, takeaways, bus or train stations, local parks, playgrounds and taxi ranks, or through the use of social media. In some cases, perpetrators are known to use younger men, women, boys or girls to befriend the exploited child or young person. Children and young people who are themselves the victims of exploitation may introduce other young people to their abusers in an attempt to deflect the abuser’s attention from themselves.
Young people may have contact with health services due to a sexual health matter or their contact may be about another health matter. This guidance will consider presentations for sexual health or other risk taking/vulnerable presentations plus encourage staff to generally ask about well being at all health presentations.
The following are typical vulnerabilities in children prior to exploitation;
It is important to note that not all situations that exhibit one, or even several, of these indicators will necessarily be sexual exploitation. Additionally children and young people that are the victims of sexual exploitation often do not recognise that they are being exploited.
There are specific risks associated with the internet in terms of child sexual exploitation, including:
Therefore when undertaking an assessment around child sexual exploitation practitioners should consider what risks are posed to the child or young person through the internet, and those that are posed by the child or young person to other children or young people. Child Protection Guidance, Scottish Government, 2014
There is increase in concern that sexual exploitation of males is less likely to be recognised and is under reported, this should be borne in mind.
PHYSICAL HEALTH presentations of CSE
MENTAL HEALTH presentations of CSE
These may include:
• Poor self-care
• Sexually transmitted infections
• Contraceptive advice
• Drug and alcohol problems
• Medically unexplained symptoms.
These may include:
• Emotional symptoms
• Trauma symptoms
• Self-harming behaviour
• Problem behaviours e.g. running away, risk-taking behaviours
• Problems in relationships.
Focus group work has shown that young people prefer to be asked sensitive questions in a professional but conversational manner. Staff may need to rephrase questions to suit individuals, and avoid using language that may be unfamiliar to young people such as medical jargon. Spotting the signs, a national proforma for identifying risk of child sexual exploitation in sexual health services, April 2014
When asking questions about sexual contact, find out what term the young person feels comfortable using as they may not perceive that person as a partner.
If you consider a young person is at risk from their replies to the questions you must follow your current local child protection processes or seek further advice from the Child Protection Unit (0141 451 6605).
Any health professional that has concerns that a child is at risk of abuse through sexual exploitation must make a referral in accordance with child protection procedures. This includes circumstances where there is a lack of evidence or where there may be concerns which cannot be substantiated. Referrals can help to build up a picture that a child may be suffering harm through sexual exploitation. It is important that practitioners do not wait for a disclosure from a young person or the accumulation of “hard” evidence, prior to making a referral.
Sexual exploitation is abuse and should be treated accordingly. Practitioners should be mindful that a “dual approach” is key in tackling CSE; whilst a young person must be both engaged with and supported, there must also be a focus on proactive investigation and prosecution of those involved in sexually exploiting the young person. Child Protection Guidance, Scottish Government, 2014
It is important that practitioners are aware that young people who are victims of CSE rarely directly disclose because they often do not recognise their own exploitation. For example, a young person may believe themselves to be in an “adult relationship” with their abuser. Disclosure of sexual exploitation can be particularly difficult for young people; the sophisticated grooming and priming processes conducted by perpetrators and the exchange element of this form of abuse can act as additional barriers to disclosure.
Examples of other reasons for non-disclosure include:
Consider the following when seeing young people who present to health about their sexual health/risk taking behaviours/episodes of self harm/strong indicators of CSE:
Confidentiality must be explained properly to young people, including its parameters and the fact that you will need to seek advice if you believe they are at risk of significant harm. Of note is that a young person may perceive their situation as consensual when in fact they are being groomed.
Normal child protection procedures should be followed if you have concerns regarding the safety and well being of children and young people. Support and guidance is available via the Child Protection Unit as usual on 0141 451 6605 and via the Child Protection website.
NHSGGC has produced a training module on child sexual exploitation that can be accessed via Learnpro.
Last reviewed: 30 June 2015
Next review: 30 June 2018
Author(s): Marie Valente
Approved By: Child Protection Forum